2014-02-13T13:58:10-06:00 2013-03-31 990 2012-04-01 381459366 CHARLEVOIX AREA HOSPITAL CHAR 2315474024 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 LYN JENKS 2315474024 2014-02-13 false 2012 2015-11-30 17:44:51Z LYN JENKS 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 39684244 false X WWW.CAH.ORG X 1919 MI TO PROVIDE EXCELLENT HEALTHCARE. 14 10 379 57 200864 67768 274383 195000 33233011 39232741 179243 31128 109631 103419 33796268 39562288 0 0 21188447 21344081 0 0 14052496 17993561 35240943 39337642 -1444675 224646 26227208 26923065 9184499 9575829 17042709 17347236 X TO PROVIDE EXCELLENT HEALTHCARE. false false 8922220 17167405 OPERATING ROOM SERVICES - SURGERIES: 2,779 6828808 6438212 PRIMARY CARE SERVICES: 23,051 3381578 4445739 EMERGENCY ROOM SERVICES - PATIENTS SEEN IN THE ER: 11,772 13599771 11510932 OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 11,772 13599771 11510932 32732377 true true false true false false false false false false true true false true false false false true false false false false false false false false true true false false true true false false false false false false false false true true false false false false false true true true false false true 50 0 true 379 true true true false false false false false false false false false X 14 10 false true false false false false false true true false false true true true true true true true true false X TABITHA RUDOLPH 2315478508 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 X MARC LAME MD 40.00 X 288899 0 10050 WILLIAM JACKSON 40.00 X X 186771 0 19011 MICHAEL HARMELING MD 40.00 X X 162929 0 20035 STEVE HUFFORD OD 1.00 X X 0 0 0 SCOTT BEATTY 1.00 X X 0 0 0 MARY JASON 1.00 X X 0 0 0 RICHARD FISH DDS 1.00 X 0 0 0 REBECCA HANEY 1.00 X 0 0 0 HAROLD PERKINS 1.00 X 0 0 0 STEVE WEBER 1.00 X X 0 0 0 RUTH B HOPPE MD 1.00 X X 0 0 0 JOHN KURTZ 1.00 X 0 0 0 MICHAEL ORTWINE 1.00 X 0 0 0 MARILYN DUMBAULD 1.00 X 0 0 0 KATHY WEBER 1.00 X 0 0 0 MELODIE BROWN MD 1.00 X 0 0 0 MARY FACULAK 1.00 X 0 0 0 NANCY SHERMAN 1.00 X 0 0 0 MARK ECKHARDT 1.00 X 0 0 0 JOSEPH SCHODDE 40.00 X 140160 0 18309 GLADYLYN JENKS 40.00 1.00 X 65167 50000 0 ROBERT ZIMMERMAN 8.00 X 0 0 0 MARY IVEY MD 40.00 X 367279 0 18301 JAMES JEAKLE MD 40.00 X 322028 0 20660 CRAIG WENDT MD 40.00 X 290776 0 12852 CATHERINE WONSKI MD 40.00 X 216792 0 21386 BRIAN DISHINGER MD 40.00 X 202092 0 10935 2242893 50000 151539 24 false true false PINE RIVER MEDICAL ASSOCIATES 14734 PARK AVENUE CHARLEVOIX MI 49720 ER PHYSICIAN 1442825 ALLIANCE-HNI LLC 525 S GOULD OWOSSO MI 48867 MOBILE MRI SERV 372794 QUEST DIAGNOSTICS 4444 GIDDINGS ROAD AUGURN HILLS MI 48326 LABORATORY SERV 201633 PLANTE & MORAN PLLC 600 EAST FRONT ST TRAVERSE CITY MI 49686 AUDIT & ACCOUNT 157935 MUNSON SUPPORT SERVICES 1105 SIXTH STREET TRAVERSE CITY MI 49685 LAUNDRY SERVICE 125309 6 187734 7266 7913 195000 HEALTH SERVICES 621110 32705388 32705388 OTHER RELATED REVENUE 621110 6326489 6326489 OTHER HEALTH SERVICES 621110 200864 200864 39232741 29628 29628 97181 121956 -24775 -24775 -24775 1500 1500 1500 1500 CAFETERIA SALES 128194 128194 128194 39562288 39007102 200864 159322 960738 518557 442181 16405830 14345058 2060772 261918 218464 43454 2551755 2184749 367006 1163840 981019 182821 56250 56250 74420 74420 176935 176935 3546310 3019309 527001 126024 126024 47020 34450 12570 179131 179131 757585 618568 139017 69887 60892 8995 67753 41089 26664 104836 85598 19238 2044532 1669360 375172 222463 66452 156011 SUPPLIES 7129904 6773612 356292 PROVISION FOR BAD DEBTS 1411205 1411205 QAAP TAX 697796 697796 EQUIPMENT SERVICE & RENTA 590457 493960 96497 691053 210035 481018 39337642 32732377 6605265 0 186619 226280 37404 1794055 25347 21421 4958932 4828835 137968 141375 372078 814582 892940 401978 46057591 31349861 16284119 14707730 72632 79134 1668278 1693952 1590891 2213723 26227208 26923065 3203562 4624769 4092706 2371715 1888231 2579345 9184499 9575829 X 16187042 16591741 855667 755495 17042709 17347236 26227208 26923065 X 224646 79881 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4824 4824 false SCHEDULE C, PART II-B, LINE 1 PORTION OF ANNUAL DUES PAID TO THE MICHIGAN HEALTH & HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION THAT ARE USED TOWARDS LOBBYING ACTIVITIES. 502714 502714 29306268 19071620 10234648 16090887 12278241 3812646 157722 157722 14707730 INVESTMENT IN CHARLEVOIX NURSING HOM 959878 F INVESTMENT IN CHARLEVOIX FOUNDATION 734074 F 1693952 COST REPORT SETTLEMENT RECEIVABLE 1775475 AFFILIATE RECEIVABLE 189326 BOND ISSUE COSTS 142047 ACCRUED MEANINGFUL USE FUNDING RECEI 106875 2213723 38273039 -1411205 -1411205 39684244 -121956 -121956 39562288 38048393 -1411205 -1411205 39459598 -121956 -121956 39337642 REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D PROVISION FOR BAD DEBT -1,411,205 REVENUE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 4B RENTAL EXPENSES -121,956 EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D PROVISION FOR BAD DEBT -1,411,205 EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 4B RENTAL EXPENSES -121,956 true true X true X true X true true true false true true 238845 99754 139091 0.00360 3713718 2361301 1352417 0.03470 3952563 2461055 1491508 0.03830 384460 5521 378939 0.00970 384460 5521 378939 0.00970 4337023 2466576 1870447 0.04800 true 1411205 189840 9816468 9729213 87255 X true true 1 1 CHARLEVOIX AREA HOSPITAL

14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720

X X X CHARLEVOIX AREA HOSPITAL 1 true X X X X X X X X X X 12 true true true X X X X X X X X X X false false true true 200.0 true 300.0 true X X X X true true X X false false true X false false 5 BOYNE AREA MEDICAL CENTER

223 N PARK BOYNE CITY MI 49712

OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX WOMEN'S HEALTH CARE

14651 W UPRIGHT STREET CHARLEVOIX MI 49720

OUTPATIENT PHYSICIAN OFFICE CHARLEVOIX SURGEONS

14695 PARK AVENUE CHARLEVOIX MI 49720

PHYSICIAN OFFICE PHYSICIAN CLINIC OF CHARLEVOIX

14705 W UPRIGHT STREET CHARLEVOIX MI 49720

PHYSICIAN OFFICE PINE RIVER CLINIC

14374 PARK AVE CHARLEVOIX MI 49720

FAMILY PRACTICE OFFICE OTHER TESTING METHODS FOR FREE OR DISCOUNTED CARE PART I LINE 3C IN ADDITION TO USE OF THE FEDERAL POVERTY GUIDELINES PATIENTS MUST ALSO SATISFY AN ASSET TEST LIMIT OF 62000 FURTHERMORE TOTAL MEDICAL DEBT WILL BE CONSIDERED ON A CASE BY CASE BASIS AS AN ADDITIONAL ELEMENT IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE SUBSIDIZED HEALTH SERVICES EXPLANATION PART I LINE 7G THE HOSPITAL DID NOT REPORT SUBSIDIZED HEALTH SERVICES EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE PART I LINE 7 COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990 PART IX LINE 24C BUT SUBTRACTED FOR PURPOSES OF CALCULATING THIS SCHEDULE H PART I COLUMN F PERCENTAGE EQUALS 1411205 COSTING METHODOLOGY EXPLANATION PART I LINE 7 A COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 IS USED FOR LINES 7A AND 7B ACTUAL COSTS ARE REPORTED ON LINE 7E BAD DEBT EXPENSE EXPLANATION PART III LINE 4 ACCOUNTS RECEIVABLE ACCOUNTS RECEIVABLE FOR PATIENTS INSURANCE COMPANIES AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRDPARTY COVERAGE THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS IF NECESSARY FOR EXAMPLE FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRDPARTY PAYOR HAS NOT YET PAID OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY FOR RECEIVABLES ASSOCIATED WITH SELFPAY PATIENTS WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRDPARTY COVERAGE EXISTS FOR PART OF THE BILL THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE THE DIFFERENCE BETWEEN THE STANDARD RATES OR THE DISCOUNTED RATES IF NEGOTIATED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE THE HOSPITAL PROVIDES CARE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY WHILE THE HOSPITAL MAKES EVERY EFFORT TO IDENTIFY ALL CANDIDATES WHO WOULD QUALIFY UNDER ITS FINANCIAL ASSISTANCE POLICY THERE ARE CIRCUMSTANCES UNDER WHICH THAT DETERMINATION CANNOT BE MADE AS SUCH IT IS OUR BELIEF THAT 189840 OF BAD DEBT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS CHARITY CARE POLICY AND SHOULD BE INCLUDED AS COMMUNITY BENEFIT BASED ON AN ANALYSIS OF SELF PAY ENCOUNTERS WHOSE GROSS CHARGES EXCEEDED 1000 AND THEREFORE WERE AUTOMATICALLY SENT A FINANCIAL ASSISTANCE APPLICATION IT WAS DETERMINED THAT APPROXIMATELY 45 QUALIFIED FOR FINANCIAL ASSISTANCE THIS PERCENTAGE WAS THEN APPLIED TO SELF PAY BAD DEBT AND THEN CONVERTED TO COST THROUGH APPLICATION OF THE RATIO OF PATIENT CARE COST TO CHARGES MEDICARE EXPLANATION PART III LINE 8 THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT WHICH DOES NOT SHOW A SHORTFALL THIS IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT COLLECTION PRACTICES EXPLANATION PART III LINE 9B THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE NEEDS ASSESSMENT PART VI CHARLEVOIX AREA HOSPITAL HAS PARTICIPATED IN NEEDS ASSESSMENT SURVEYS CONSISTENTLY DURING THE PAST 10 YEARS TYPICALLY IN COOPERATION WITH OTHER ORGANIZATIONS BUT AT TIMES SPECIFICALLY DRIVEN BY OUR HOSPITAL IN ADDITION TO DATA PROCURED THROUGH THESE SURVEYS OUR HOSPITAL HAS ALSO USED MICHIGAN DEPARTMENT OF COMMUNITY HEALTH DATA AND DATA FROM THE ECONOMIC DEVELOPMENT COUNCIL TO ASSESS THE ONGOING HEALTHCARE NEEDS OF OUR COMMUNITY THE SURVEYS HAVE RESULTED IN MANY JOINT EFFORTS TO ADDRESS OUR COMMUNITYS HEALTH CARE NEEDS FLU CLINICS IN COOPERATION WITH LOCAL MDCH GRANT PROCUREMENT FOR PACS AND DIGITAL MAMMOGRAPHY AND FITKIDS ADDITIONALLY THE HOSPITAL HAS SOLELY SPONSORED WELLNESS WEDNESDAYS FREE MAMMOGRAPHY AND SPORTS PHYSICALS FOR STUDENT ATHLETES PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE PART VI INFORMATION REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE HOSPITALS ADMISSIONS AREAS IF DURING THE REGISTRATION PROCESS IT BECOMES APPARENT THAT A PATIENT HAS NEED FOR POSSIBLE FINANCIAL OR DISCOUNTED ASSISTANCE A REFERRAL IS MADE TO THE HOSPITALS FINANCIAL COUNSELOR OR SOCIAL WORKER DURING THIS ASSESSMENT ELIGIBILITY FOR ASSISTANCE UNDER EXISTING FEDERAL STATE OR LOCAL GOVERNMENT PROGRAMS IS FIRST EXPLORED SHOULD THE PATIENT FAIL TO QUALIFY FOR EXISTING PROGRAMS THE HOSPITALS FINANCIAL ASSISTANCE APPLICATION IS MADE AVAILABLE IN THE EVENT THE PATIENTS NEED IS NOT IDENTIFIED DURING REGISTRATION ADDITIONAL OPPORTUNITIES TO INQUIRE ABOUT FINANCIAL ASSISTANCE ARE MADE AVAILABLE FOR EXAMPLE THE PHONE NUMBER FOR INQUIRIES INTO FINANCIAL ASSISTANCE ARE PRINTED ON ANY STATEMENTS SENT TO THE PATIENT FURTHERMORE PATIENTS WHO DO NOT HAVE INSURANCE COVERAGE AND HAVE AN ENCOUNTER BALANCE THAT EXCEEDS 1000 ARE AUTOMATICALLY SENT AN APPLICATION COMMUNITY INFORMATION PART VI CHARLEVOIX AREA HOSPITAL SERVES THE RESIDENTS OF CHARLEVOIX AND NORTHERN ANTRIM COUNTIES AS WELL AS THE SEASONAL RESIDENTS THAT FLOOD THE AREA DURING THE SUMMER MONTHS THIS SMALL RURAL COMMUNITY IS HOME TO APPROXIMATELY 26000 RESIDENTS WITH A PER CAPITA INCOME OF APPROXIMATELY 40000 BASED ON 2008 ESTIMATES 112 OF THE POPULATION HAD INCOMES BELOW THE POVERTY LEVEL SIMILARLY MEDICAID RECIPIENTS ACCOUNTED FOR APPROXIMATELY 12 OF THE HOSPITALS GROSS PATIENT CHARGES IN ADDITION PATIENTS REFERRED FROM NEIGHBORING EAST JORDAN FAMILY HEALTH CENTER A FEDERALLY QUALIFIED RURAL HEALTH CLINIC WERE AMONG THOSE SERVED BY THE HOSPITAL HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE PART VI THE BOARD OF DIRECTORS IS COMPRISED OF MEDICAL AND BUSINESS PROFESSIONALS ALMOST ALL OF WHOM RESIDE IN THE HOSPITALS PRIMARY SERVICE AREA THIS VOLUNTARY BOARD PROVIDES COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS IN FUNDRAISING AND IN GENERAL STEWARDSHIP MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY SUBJECT TO CREDENTIALING REVIEW AND REQUIREMENTS OF THE MEDICAL STAFF AND THE BOARD OF DIRECTORS CHARLEVOIX AREA HOSPITAL UTILIZES SURPLUS FUNDS TO MAINTAIN ACCESS TO PATIENT SERVICES AND IMPROVE CARE TO PATIENTS THROUGHOUT ITS SERVICE AREA EXAMPLES OF HOW CAH PROMOTES THE HEALTH OF THE COMMUNITY THROUGH PROGRAMS INCLUDE AMERICAN RED CROSS BLOOD DRIVES AREA BUSINESS HEALTH SCREENINGS FREEDOM FROM SMOKING CLINIC FIT4LIFE FOR ADULTS WEIGHT WATCHERS AT WORK CIRCLE OF STRENGTH CANCER SUPPORT GROUP CIRCLE OF STRENGTH MAMMOGRAM VOUCHERS PINK RIBBON RIDE FIT4LIFE FOR KIDS HOSPITAL AND CAREER EXPLORATION TOURS READ TO ME PROGRAM SCHOOL NURSE PROGRAM AFFILIATED HEALTH CARE INFORMATION PART VI THE HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED PART VI MICHIGAN CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 3 PART V LINE 3 MAJOR PARTNERS IN THE EXECUTION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT WERE THE NORTHWEST MICHIGAN COMMUNITY HEALTH DEPARTMENT AND HEALTH DEPARTMENT DISTRICT 4 ALONG WITH HOSPITAL PARTNERS AS DESCRIBED IN V4 AND THE NORTHERN HEALTH PLAN THESE PARTNERS FORMED THE STEERING COMMITTEE THAT DEVELOPED THE PLAN FOR THE ASSESSMENT THEN FOLLOWED IT THROUGH TO FULL EXECUTION IN ADDITION MORE THAN 1200 INDIVIDUALS PARTICIPATED IN SURVEYS ANDOR FOCUS GROUPS THROUGHOUT NORTHERN MICHIGAN IN 2012 ABOUT 900 RESIDENTS COMPLETED THE HEALTHY COMMUNITY SURVEY INCLUDING 226 FROM ANTRIM AND CHARLEVOIX COUNTIES APPROXIMATELY 100 PHYSICIANS NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS COMPLETED A HEALTH CARE PROVIDER SURVEY MORE THAN 200 PEOPLE FROM ACROSS THE NORTHERNMOST PART OF THE LOWER PENINSULA OF MICHIGAN INCLUDING EMMET CHARLEVOIX OTSEGO CHEBOYGAN CHARLEVOIX AND ANTRIM COUNTIES PARTICIPATED IN 22 FOCUS GROUPS COMMUNITY DIALOGUES AND KEY INFORMANT INTERVIEWS THESE INCLUDED COMMUNITY HEALTH NEEDS ASSESSMENT ACTIVITIES LED BY MUNSON MEDICAL CENTER WHICH COVERED ANTRIM COUNTY CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 4 PART V LINE 4 MCLAREN NORTHERN MICHIGAN PETOSKEY MI OTSEGO MEMORIAL HOSPITAL GAYLORD MI CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 7 PART V LINE 7 ABUSE AND NEGLECT WE HAVE NO CURRENT PLANS TO ADDRESS THIS ISSUE AS THERE ARE OTHER AGENCIES AND ORGANIZATIONS WITHIN OUR REGION THAT ROUTINELY PROVIDE PREVENTIVE AND OTHER SERVICES FOR THIS POPULATION INCLUDING THE WOMENS RESOURCE CENTER NORTHERN MICHIGAN COMMUNITY MENTAL HEALTH THE CHILD ABUSE PREVENTION COUNCIL AND THE HEALTH DEPARTMENT OF NORTHWEST MICHIGAN MATERNAL SMOKING WE HAVE NO CURRENT PROGRAMS SPECIFICALLY TARGETING SMOKING MOTHERS BUT WE WILL WORK WITH AREA PHYSICIANS TO REFER THEM TO AVAILABLE SMOKING CESSATION PROGRAMS PROVIDED AS NOTED ELSEWHERE IN THE PLAN IN ADDITION A CAH RESPIRATORY THERAPIST IS CONSULTED TO INSTRUCT IN THE DANGER OF SECONDHAND SMOKE WITH EACH NEWBORN MOTHER WITH A SMOKING HABIT A SMOKING CESSATION PACKET IS PROVIDED WITH QUITTING TECHNIQUES AND STATE AND LOCAL RESOURCE INFORMATION THE LOCAL PUBLIC HEALTH DEPARTMENT PROVIDES SIGNIFICANT SUPPORT TO EXPECTANT MOTHERS IN THIS AREA ALONG WITH ADDITIONAL COUNSELING ON OTHER FORMS OF ADDICTION CHARLEVOIX AREA HOSPITAL LINE NUMBER 1 PART V LINE 20D PART V LINE 20D A PERCENTAGE DISCOUNT RANGING FROM 20 TO 100 IS APPLIED TO GROSS CHARGES FOR INDIVIDUALS WHO QUALIFY FOR FINANCIAL ASSISTANCE THE DISCOUNT IS DETERMINED ON A SLIDING SCALE USING THE FEDERAL POVERTY GUIDELINES GRID FOR INCOMES UP TO 300 OF THE FEDERAL POVERTY LEVEL AND TAKING INTO ACCOUNT THE NUMBER OF MEMBERS IN THE FAMILY THE 20 DISCOUNT EXCEEDS THE DISCOUNT NEGOTIATED WITH CHARLEVOIX AREA HOSPITALS TWO LARGEST PRIVATE INSURERS WHICH REPRESENT 30 OF OUR PAYER MIX X X X true false false false false false false false false MARC LAME MD 288284 615 10050 298949 WILLIAM JACKSON 141552 45219 3393 15618 205782 MICHAEL HARMELING MD 139237 23383 309 2877 17158 182964 JOSEPH SCHODDE 58110 82050 2543 15766 158469 MARY IVEY MD 209450 143148 14681 4353 13948 385580 JAMES JEAKLE MD 206209 113830 1989 4213 16447 342688 CRAIG WENDT MD 287924 615 2237 12852 303628 CATHERINE WONSKI MD 183163 27697 5932 3763 17623 238178 BRIAN DISHINGER MD 161238 27000 13854 3373 7562 213027 SEVERANCE, NONQUALIFIED, AND EQUITY-BASED PAYMENTS SCHEDULE J, PAGE 1, PART I, LINE 4 JOSEPH SCHODDE 52,560 0 0 OTHER ADDITIONAL INFORMATION SCHEDULE J, PART III SEVERANCE COMPENSAION: SUBJECT TO REVIEW AND APPROVAL BY THE BOARD, IN ORDER TO RECRUIT AND MAINTAIN QUALIFIED EXECUTIVES, A COMPETITIVE BENEFIT PACKAGE WAS OFFERED TO THE CHIEF FINANCIAL OFFICER WHICH INCLUDED A SEVERANCE PROVISON IN THEIR EMPLOYMENT CONTRACT. THERE IS NO FORMAL SEVERANCE PLAN AT CHARLEVOIX AREA HOSPITAL. A CHARLEVOIX TWP HOSP FIN AUTH 2001 383203086 2013-03-28 3230010 REFUND/REISSUE 2001 SERIES CHARLEVOIX TOWNSHIP HOSPITAL FINANCE AUTHORITY false false false A 3230010 3230010 true false true true A false false false false false false false false A false false true false false false false false false A false PURPOSE OF ISSUE DESCRIPTION SCHEDULE K CHARLEVOIX TWP HOSP FIN AUTH 2001 LIMITED OBLIGATION HOSPITAL REVENUE AND REFUNDING BONDS ISSUE DATE 11132001 ADDITIONAL INFORMATION SCHEDULE K CHARLEVOIX TWP HOSP FIN AUTH 2001 CHARLEVOIX AREA HOSPITAL IS IN THE PROCESS OF ADOPTING WRITTEN PROCEDURES FOR POSTISSUANCE COMPLIANCE WHICH WILL INCLUDE PROVISIONS TO ENSURE VIOLATIONS OF FEDERAL TAX REQUIREMENTS ARE TIMELY IDENTIFIED AND CORRECTED THROUGH A VOLUNTARY CLOSING AGREEMENT PROGRAM IF SELFREMEDIATION IS NOT AVAILABLE KAYE BEATTY WIFE OF BOARD M 35892 COMPENSATION false PINE RIVER MEDICAL ASSOCIATES BOARD MEMBER 1474678 INDEPENDENT false ADDITIONAL INFORMATION SCHEDULE L PART V A NAME OF PERSON KAYE BEATTY B RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION WIFE OF BOARD MEMBER SCOTT BEATTY D DESCRIPTION OF TRANSACTION COMPENSATED AS AN EMPLOYEE OF THE HOSPITAL A NAME OF PERSON PINE RIVER MEDICAL ASSOCIATES B RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION BOARD MEMBER MELODIE BROWN IS AN OWNER OF PINE RIVER MEDICAL ASSOCIATES D DESCRIPTION OF TRANSACTION INDEPENDENT CONTRACTOR ARRANGEMENT FOR ER AND HOSPITALIST PHYSICIAN SERVIES 1104617 PROFESSIONAL SERVICES AGREEMENT 47333 TRANSCRIPTION SERVICES PROVIDED BY THE HOSPITAL TO PINE RIVER 25200 RENTAL OF SPACE AND OFFICE STAFF FOR HOSPITALEMPLOYED PEDIATRICIAN HOUSED AT PINE RIVER 207000 RENTAL OF PHYSICIAN OFFICE BUILDING TO PINE RIVER BY THE HOSPITAL 30834 DURING 2013 CHARLEVOIX AREA HOSPITAL PURCHASED THE ASSETS OF PINE RIVER MEDICAL ASSOCIATES FOR 48180 AND EXECUTED A THREE YEAR NONCOMPETE AGREEMENT FOR 10000 ALL OTHER ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4D OUTPATIENT CARE, DIAGNOSTIC AND LABORATORY SERVICES, EMERGENCY ROOM SERVICES, AND OTHER GENERAL HEALTHCARE SERVICES. PATIENTS SEEN IN THE EMERGENCY ROOM TOTAL 11,772 MANAGEMENT DELEGATED FORM 990, PAGE 6, PART VI, LINE 3 CHARLEVOIX AREA HOSPITAL CONTRACTED THE CHIEF FINANCIAL OFFICER RESPONSIBILITIES TO MUNSON HEALTHCARE, AN AFFILIATE HEALTHCARE SYSTEM IN ITS SERVICE AREA. MUNSON HEALTHCARE ASSIGNED ROBERT ZIMMERMAN TO FULFILL THAT ROLE. NONE OF CHARLEVOIX AREA HOSPITAL'S CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY MUNSON HEALTHCARE DURING THE CALENDAR YEAR ENDED IN CHARLEVOIX'S TAX YEAR. ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B CAH CONTRACTS FOR CERTAIN ACCOUNTING SERVICES FROM MUNSON HEALTHCARE WHICH INCLUDE ASSISTANCE WITH THE FORM 990 PREPARATION AND REVIEW. A REVIEW OF THE 990 IS PERFORMED BY THE ADMINISTRATIVE TEAM AS WELL AS THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING THE RETURN. ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C ALL INDIVIDUALS SERVING ON THE BOARD ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND ARE PERIODICALLY REMINDED OF THEIR OBLIGATION TO REPORT ANY POTENTIAL CONFLICTS OF INTEREST THAT MAY ARISE AS PART OF INTERRELATIONSHIPS RESULTING FROM THEIR PROFESSIONAL CAREERS, THEIR FAMILIES, THEIR PERSONAL ACQUAINTANCES WITH KEY EMPLOYEES OF THE HOSPITAL, AND THEIR DUTIES AS A BOARD MEMBER. MONITORING IS CONDUCTED ON AN ONGOING BASIS, WITH THE EXPECTATION THAT BOARD MEMBERS WILL MEET THEIR AFFIRMATIVE OBLIGATION TO REPORT CONFLICTS OF INTEREST PRIOR TO THE EXECUTION OF BOARD TRANSACTIONS INVOLVING SUCH CONFLICTS. CHARLEVOIX AREA HOSPITAL CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY BY DISTRIBUTING AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE TO BOARD MEMBERS, EMPLOYED PHYSICIANS, AND KEY EMPLOYEES, WHICH INCLUDES QUESTIONS RELATED TO EACH POLICY PROVISION. RESPONSES ARE THOROUGHLY REVIEWED AND ANY APPARENT CONFLICTS ARE THOROUGHLY INVESTIGATED. IN THE EVENT THAT A POTENTIAL CONFLICT IS IDENTIFIED PRIOR TO ACTION ON A CONTRACT OR TRANSACTION, THE CONFLICTED PERSON IS NOT ALLOWED TO PARTICIPATE INDISCUSSIONS ON THE MATTER, NOT ALLOWED TO VOTE ON THE MATTER, AND NOT ALLOWED TO BE PRESENT DURING VOTING ON THE MATTER. COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A THE PROCESS FOR DETERMINING COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER (CEO)WAS WORKED THROUGH THE BOARD EXECUTIVE COMMITTEE, WHICH INCLUDED THREE INDIVIDUALS, ALL OF WHOM WERE/ARE INDEPENDENT (IE, UNDER NO COMPENSATION AGREEMENT, NOR UNDER CONTROL OF ANYONE BEING COMPENSATED). THE PROCESS INCLUDED A DATA COLLECTION PHASE WHICH REVIEWED ARTICLES DEALING WITH CONTEMPORARY PHILOSOPHY OF CEO COMPENSATION, AND ALSO INCLUDED A REVIEW OF THE VARIOUS QUARTILES OF CEO COMPENSATION FOR CRITICAL ACCESS HOSPITALS COMPILED IN 2012 BY YAFFE AND CO., INC. FOLLOWING THIS PHASE OF DATA COLLECTION, THE EXECUTIVE COMMITTEE CAREFULLY DELIBERATED IN SETTING THE COMPENSATION LEVEL FOR FY 2013/14 BASED ON DATA FROM SIMILARLY FINANCIALLY-SIZED CRITICAL ACCESS HOSPITALS IN THE MIDWEST. IT ADDITION, AN OUTLINE FOR A COMPENSATION STRUCTURE FOR THE NEXT FIVE YEARS WAS DEVELOPED, WHICH ALSO INCLUDES AN INCENTIVE COMPONENT. THE FULL BOARD REVIEWED AND APPROVED THE PROCESS, BUT DID NOT PARTICIPATE IN THE DELIBERATION ABOUT COMPENSATION, NOR IN THE FINAL DECISION. COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B CHARLEVOIX AREA HOSPITAL CONTRACTS WITH MUNSON HEALTHCARE TO PROVIDE MANAGEMENT SERVICES FOR ITS CHIEF FINANCIAL OFFICER, FINANCE DIRECTOR AND REIMBURSEMENT RESPONSIBILITIES. THIS CONTRACT DICTATES FIXED MONTHLY PAYMENTS TO MUNSON HEALTHCARE. THE PAYMENTS WERE DERIVED FROM THE COST-BASED HOURLY RATE SET BY MUNSON FOR ITS PERSONNEL. THE CHARLEVOIX AREA HOSPITAL BOARD OF DIRECTORS REVIEWED THE CONTRACT FOR REASONABLENESS AND APPROVED THE CONTRACT. GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLIT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPSON REQUEST. RELATED ORGANIZATIONS FORM 990, PAGE 7, PART VII LYN JENKS, PRESIDENT OF CHARLEVOIX AREA HOSPITAL, SPENDS APPROXIMATELY 1 HOUR A WEEK FOR THE CHARLEVOIX AREA HOSPITAL FOUNDATION. RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 PROVISION FOR BAD DEBT -1,411,205 RENTAL EXPENSES 121,956 PROVISION FOR BAD DEBT 1,411,205 RENTAL EXPENSES -121,956 OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 AFFILIATE TRANSFER 79,881 TRANSFER FROM FOUNDATION AFFILIATE 79,881 CHARLEVOIX AREA HOSPITAL FOUNDATION CHARLEVOIX AREA HOSPITAL FOUNDATION 14700 LAKE SHORE DRIVE CHARLEVOIX MI 49720 753078034 FUNDRAISIN MI 501C3 11A CHARLEVOIX AREA HOSPITAL true false false true false false false false false false false false false false false true false true false false CHARLEVOIX AREA HOSPITAL FOUNDATION C 267617 CASH CHARLEVOIX AREA HOSPITAL FOUNDATION N 45908 FMV ACTUAL AMOUNTS PAID CHARLEVOIX AREA HOSPITAL FOUNDATION P 102231 FMV ACTUAL AMOUNTS PAID